Response to Notice of Revised Determination

Response to Notice of Revised Determination

OMB: 0960-0347

IC ID: 9225

Information Collection (IC) Details

View Information Collection (IC)

Response to Notice of Revised Determination
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.1413-.1414 20 CFR 416.1492(d) 20 CFR 404.992(b) 20 CFR 404.913-.914

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-765 Response to Notice of Revised Determination SSA-765 (revised).pdf No   Paper Only
Other-Revised Privacy Act Statement SSA-765 - Updated PA Statement.pdf No   Paper Only
Other-Paperwork Reduction Act (revised) 0347 PRA (revised).docx No   Paper Only

Income Security General Retirement and Disability

 

1,925 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,925 0 0 0 0 1,925
Annual IC Time Burden (Hours) 2,695 0 0 0 0 2,695
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-765 SSA-765 (current).pdf 04/22/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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